Prevalence of adverse neonatal events and their association with neonatal health care practices of mothers in squatter settlements of Karachi, Pakistan

Date of Award


Document Type


Degree Name

Master of Science in Epidemiology & Biostatistics (MSc Epidemiology & Biostats)


Community Health Sciences


During past few decades there has been considerable emphasis on reducing child mortality largely through immunization and oral dehydration. This resulted in sustained decline in infant mortality; however neonatal mortality has remained relatively unchanged. Worldwide neonatal mortality is estimated to be 4 million annually, of which 99% are in developing countries, where most of newborns are delivered at home and die without reaching health care facility. There is a huge gap in reliable information on the magnitude and factors associated with neonatal mortality and morbidity in communities. This study aimed to estimate the prevalence of adverse neonatal events and neonatal health care practices of mothers in squatter settlements of Karachi, Pakistan. It also sought to assess the association of adverse neonatal events with neonatal health care practices of mothers. A cross-sectional study was conducted from August 2006 to November 2006 in Azam Basti and near by areas. Data was collected from recently delivered women between 28 and 33 days post delivery. A structured questionnaire was used to obtain information on 565 women in the study area. Data was analyzed using appropriate descriptive analysis and multiple logistic regression analysis. Prevalence of adverse neonatal events was 5.3% (95 %CI:3.5%,7.1%).Neonatal mortality rate was estimated to be 27/1000 live births. Most of neonatal adverse events (90%) were observed during the first week of birth. Of these 45% were seen on first day of life. Receiving antenatal care from a skilled provider was common (72.4%) although only half of women received four visits from skilled provider. Although tetanus toxoid immunization coverage during pregnancy was common, iron and appropriate folic acid use was reported by only 23% and 16% of women. About 56% of deliveries were conducted in health care facility. Among women whose neonate had an adverse event about 73% received appropriate antenatal care and 77% were born in health care facility. A high prevalence of unhealthy newborn care practices were seen in the study area. About 56% of the newborns were bathed immediately after birth. Although majority of the women (97%) reported breast feeding the newborns, unhealthy practices like giving prelacteals (80%) and delaying first feed (80%) were common. Fifty eight percent of women applied some substance on the umbilical cord; ointment (33%) was the most commonly reported substance followed by ghee (27%), coconut oil (19%), mustard oil (9.5%) and others. Massage to the baby was universally practiced; mustard oil (73%) being most frequently used. Majority of neonates (81%) received immunization injection and polio drops after birth. Results indicated that women whose neonate had an adverse event were 4.8 times (CI:2.2,10.3) more likely to have illness during pregnancy than women whose neonate were healthy. We found reduced risk of 0.45(CI:0.27,0.75) per 5 years increase in maternal age. We also found a reduced risk of adverse events in those who belonged to lower (OR: 0.22,CI:0.07, 0.75) and middle (OR:0.36,CI:0.13, 0.95) SES. Neonatal mortality is high considering the easy availability of health care facilities in Karachi. Illness of women during pregnancy is significantly associated with adverse neonatal events. Therefore there is a need to provide continuum of care which should include care during antenatal, natal and post natal period. Unhealthy neonatal health care practices are highly prevalent in the study area. Behavioral change communication strategies are required to educate the mothers and TBAs about healthy newborn care practices.

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